The CMS is winding down its recovery audit program with its current contractors, placing the program effectively on hold—perhaps for several months—while it awards new contracts. The pause could be tacit acknowledgment of the need to address issues with the program, a healthcare analyst said.
See a slideshow of the people most likely to change the healthcare landscape in 2014.
Uncertain insurance exchange enrollment. Tough state battles over Medicaid expansion. Potentially rising healthcare costs. Hoped-for relief from Medicare payment cuts for providers. Read predictions on these and other top issues and trends the industry faces in 2014.
Outlook 2014: Obamacare, SGR repeal, ICD-10 and payment cuts top the list of challenges for healthcare players in 2014
This could be the make-or-break year for President Barack Obama's Patient Protection and Affordable Care Act, as hospitals, physicians, insurers, consumers and elected officials wonder whether it will meet its coverage expansion and cost-control goals or fall short of expectations.
Hospitals and other healthcare stakeholders will be closely watching how many of the 23 holdout states, if any, decide to expand Medicaid eligibility in 2014.
This year, millions of newly insured Americans are expected to fuel faster growth in health spending, which has notably slowed since the Great Recession hit.
As the imperative to clamp down on hospital spending grows, government investigators are likely to start wielding the False Claims Act even more aggressively than in the past.
Appealing bad decisions by Medicare's recovery audit contractors has never been easy. But the system has become so overloaded in recent months that some are calling it an administrative quagmire that is denying basic due process rights because it takes so long.
Not-for-profit hospitals enter 2014 with continued pressure on revenue growth and operating margins. Not all will get through the year without a hit to their finances or the need for a partner, industry experts say.
Publicly traded healthcare companies had another positive run in the stock market in 2013, as investors continued to be optimistic about healthcare reform. But to keep up the momentum, the chains will need to continue to make bold moves, particularly around consolidation.